Joan S, a forty-five-year-old woman, awoke one morning to find that when she brushed her teeth she felt numbness on the left side of her face. Her left eye was dry and she had difficulty closing it, plus her mouth tasted odd and she could not hold water in it. When she realized she was drooling, and began to feel that the left side of her face was paralyzed, she immediately called her husband who arranged for an ambulance to take her to the hospital, where she was given a CT scan and an MRI of the brain. The results showed she had not suffered a stroke, but during the physical examination she felt dizzy and realized she was again drooling out the left side of her mouth. She had a dry mouth, her left facial muscles were twitching, she was hypersensitive to sound, and she had developed slurred speech. The doctors diagnosed her condition as Bell’s Palsy and gave her a corticosteroid patch for ten days, decreasing the dosage daily. When there was no improvement after the ten-day treatment, she consulted her primary care physician who prescribed acyclovir, which was supposed to prevent further damaging of the facial nerve.

After a week of acyclovir, she still felt no improvement, so she returned to this same doctor and he said her symptoms should disappear spontaneously within three to six months. After three months of no improvement, she became extremely frustrated with her condition. She still felt numbness on the left side of her face and had difficulty closing her eyes and mouth, which were both drooping; she was drooling and could not smile using the left side of her mouth. Once again back with the same doctor, he advised her that things should right themselves if she gave it more time. At this point, Joan started to feel scared, so she asked around and was referred to me by her friends.

Joan’s condition, Bell’s Palsy, is a form of temporary facial paralysis resulting from damage or trauma to cranial nerve VII, one of the two facial nerves. This paralysis causes muscle distortion and interferes with such facial functions as closing the eyes, eating, and using one side of the mouth. The onset of Bell’s Palsy is usually sudden—many people wake up one morning to discover that one side of their face is paralyzed. Sometimes the symptoms are confused with a stroke, but Bell’s Palsy is definitely not a stroke, it is only due to injury to the cranial nerve VII.

Functions of Cranial Nerve VII

Cranial nerve VII has many nerve fibers, which are distributed to the scalp, the face, and the facial muscles. It supplies some of the salivary glands, which provide lubricants to the eyes and mouth and is responsible for sensations to the hearing organs—the ear canal and behind the ear.

Its nerve fibers affect the forehead and the upper eyelids, including eyebrow elevation, forehead wrinkling, frowning, and tight closing of the eyes.

Its nerve fibers in the lower face include showing the teeth, whistling, puffing the cheeks, and having a natural smile; it is also responsible for impulses to two-thirds of the tongue, including the ability to taste.

See the figure 5-1

fbr.org

Discovery, Symptoms, and Causes of Bell’s Palsy

The disease is named for Sir Charles Bell, a Scottish surgeon who discovered the nerve and its effects on the facial muscles about 200 years ago. It affects about 40,000 people in the United States each year, and is most commonly seen in young adults.

Many people think it is an inflammation and swelling of the facial nerve that leads to an the onset of Bell’s Palsy. This condition can be triggered by a virus infection, such as chicken pox, herpes simplex, herpes zoster, HIV, mononucleosis, or mumps, or by a bacterial infection, such as Lyme disease or tuberculosis. Others believe that brain-stem tumors, skull fractures, or neurological conditions, such as diabetic neuropathy or Guillain-Barré syndrome, can lead to Bell’s Palsy.

The most common symptoms are the sudden onset of paralysis or weakness of one side of the face, with difficulty closing the eyes, facial droop and difficulty with facial expressions, pain behind or in front of the ear with an amplification of sounds on the affected side, headache, loss of taste, and changes in the amount of tears and saliva.

Treatments in Western Medicine

The treatment of Bell’s Palsy is controversial in Western medicine; many people are given no treatment and are expected to recover spontaneously.

Some Western doctors prescribe the following treatments.

Medications. The one most usually prescribed is a corticosteroid, sometimes mixed with antiviruses, such as acyclovir, which are expected to help in recovery.

Physical therapy. It is believed that physical therapy can relax the strain in the facial muscle and prevent the symptoms from recurring.

Surgery. Surgery is very controversial. If the facial paralysis has not recovered after 6 months, a person can manifest many symptoms, including drooping eyes and difficulty closing them, and distortion and spasms of the facial muscles. Although such surgical procedures as facial nerve repair, facial nerve graft, facial nerve substitution, and muscle transposition are not able to completely restore normal function, they can significantly improve the face’s appearance and ability to function.

In Joan’s case, her primary care doctor thought medication alone would be sufficient treatment, so she waited three of the six months he suggested without becoming better. It was at this point that she decided to consult me.

Treatments in Traditional Chinese Medicine

Traditional Chinese medicine believes that facial paralysis is due to wind invasion. The wind attacks the facial nerve and causes nerve and muscle paralysis. Because the nerve supplies the impulses to the facial muscle, the taste buds, and the eye, paralysis causes muscle dysfunction and makes treatment of acupuncture at the appropriate points most important. And the sooner treatment starts, the better. It is not good to wait six months, or even three, as Joan did, to see if there is a spontaneous recovery; it is best to start treatment immediately because the viability of the facial nerve decreases every day. Even after six months, there is still a good chance of recovering from the paralysis, but instead of waiting that long, it is better to treat the affected person as soon as possible.

People with Bell’s Palsy are almost always nervous about their condition, and feel extremely stressed, believing their symptoms could be the signs of a stroke. For this reason, the acupuncture treatment should not only treat the paralysis, but also utilize points intended to relieve stress.

The following points used for this condition are locally selected—most of them are on the face.

Joan was treated with the above acupuncture points, which helped supply the blood flow to the nerve and decreased the muscle spasms and inflammation. She also received massages, and after one month of these treatments she completely recovered from Bell’s Palsy.

Tips for People with Bell’s Palsy

I cannot stress enough the importance of treatment as soon as possible; waiting is not an option.

Daily massages, 20 minutes per session and 3 sessions per day, combined with the above acupuncture points, will greatly help recovery. Acupressure the points with your thumb or knuckle, pressing with comfortable pressure on the points; count to 20, then change to another point. You should work symmetric points at the same time.

Tips for acupuncturists:

Mainly put needles on the paralyzed side, however, you also have to put a few needles on the healthy side, which will help the energy flow go through the paralyzed side.

After acupuncture treatment, massage for about 10 to 15 minutes will greatly help the patient’s recovery.

Most of the time, your patients will get 90% to 100% recovery, again, the earlier the treatment, the better the results.